中青年脑卒中伴与不伴高同型半胱氨酸血症患者肠道菌群特征的差异及临床意义

doi:10.3969/j.issn.1006-6233.2024.07.025

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摘要 目的: 探讨中青年脑卒中伴与不伴高同型半胱氨酸(Hcy)血症患者肠道菌群特征的差异及临床意义。方法: 选取2022年1月至2023年12月110例中青年脑卒中患者作为研究组,根据伴与不伴高Hcy血症分为高Hcy亚组与正常Hcy亚组,另选取同期健康体检志愿者55例作为对照组。对比研究组与对照组、研究组不同亚组肠道菌群失调发生率、Alpha多样及相对丰度,分析肠道菌群与高Hcy血症、脑卒中的关系,评价肠道菌群对脑卒中伴高Hcy血症的预测价值。结果: 研究组肠道菌群失调发生率52.73%高于对照组18.18%,Simpson指数(417.61±66.51)高于对照组(668.39±91.08),Chaol指数(0.96±0.06)、Shannon指数(2.13±0.52)低于对照组(0.90±0.03)、(4.67±0.45)(χ²=18.061,t=20.103、6.985、30.891,P均<0.001);研究组厚壁菌门低于对照组,拟杆菌门、变形菌门相对丰度高于对照组(P<0.05);研究组拟杆菌属相对丰度高于对照组,双歧杆菌属、粪杆菌属、柯林斯菌属相对丰度低于对照组(P<0.05);高Hcy亚组肠道菌群失调发生率80.00%高于正常Hcy亚组33.85%,Simpson指数(383.43±53.18)高于正常Hcy亚组(441.27±65.39),Chaol指数(0.99±0.05)、Shannon指数(2.02±0.18)低于正常Hcy亚组(0.94±0.03)、(2.21±0.25),(χ²=22.725,t=4.913、6.545、4.371,P均<0.001);高Hcy亚组厚壁菌门低于正常Hcy亚组,拟杆菌门、变形菌门相对丰度高于正常Hcy亚组(P<0.05);高Hcy亚组拟杆菌属相对丰度高于正常Hcy亚组,双歧杆菌属、粪杆菌属、柯林斯菌属相对丰度低于正常Hcy亚组(P<0.05);肠道菌群失调、Simpson指数与高Hcy血症、脑卒中及脑卒中伴高Hcy血症呈正相关,Chaol指数、Shannon指数与高Hcy血症、脑卒中及脑卒中伴高Hcy血症呈负相关(P<0.05);肠道菌群失调、Simpson指数、Chaol指数、Shannon指数预测中青年脑卒中伴高Hcy血症的AUC为0.731(95%CI:0.638~0.811)、0.809(95%CI:0.723~0.878)、0.782(95%CI:0.693~0.855)、0.822(95%CI:0.738~0.889),敏感度分别为80.00%、86.67%、82.22%、75.56%,特异度为66.15%、69.23%、61.54%、75.38%。结论: 中青年脑卒中伴高Hcy血症患者肠道菌群失调发生率较高,多样性下降,丰度也发生明显改变,可作为预测脑卒中伴高Hcy血症的辅助指标,能为临床提供新的角度。

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	王学明
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	姜芳

关键词 ：中青年, 脑卒中, 高同型半胱氨酸血症, 肠道菌群特征, Alpha多样性, 相对丰度, 预测价值

Abstract：Objective: To investigate the differences in gut microbiota characteristics and clinical significance between middle-aged and young stroke patients with and without hyperhomocysteinemia (Hcy). Methods: A total of 110 middle-aged and young stroke patients were enrolled as the study group from January 2022 to December 2023. According to the presence or absence of hyperhomocysteinemia, they were divided into the hyperhomocysteinemia (Hcy) subgroup and the normal Hcy subgroup. 55 healthy volunteers who underwent physical examination during the same period were selected as the control group. The incidence of gut microbiota dysbiosis, Alpha diversity, and relative abundance of the research group and control group, the research group subgroups were compared. The relationship between gut microbiota and hyperhomocysteinemia, and stroke was analyzed, and the predictive value of gut microbiota for stroke with hyperhomocysteinemia was evaluated. Results: The incidence of gut microbiota dysbiosis was significantly higher in the Hcy group (52.73%) than in the non-Hcy group (18.18%). The Simpson index (417.61±66.51) was higher in the Hcy group than in the non-Hcy group (668.39±91.08), while the Chaol index (0.96±0.06), Shannon index (2.13±0.52) were lower in the Hcy group than in the non-Hcy group (0.90±0.03), (4.67±0.45) (χ²=18.061, t=20.103, 6.985, 30.891, P<0.001). The abundance of Firmicutes was lower in the Hcy group than in the non-Hcy group, while the abundance of Bacteroidetes and Proteobacteria was higher in the Hcy group (P<0.05). The abundance of Bacteroides genus was higher in the Hcy group than in the non-Hcy group, while the abundance of Bifidobacterium genus, Faecalibacterium genus, and Collinsella genus was lower in the Hcy group (P<0.05). The incidence of gut microbiota dysbiosis was significantly higher in the high-Hcy subgroup (80.00%) than in the normal-Hcy subgroup (33.85%). The Simpson index (383.43±53.18) was higher in the high-Hcy subgroup than in the normal-Hcy subgroup (441.27±65.39), while the Chaol index (0.99±0.05), Shannon index (2.02±0.18) were lower in the high-Hcy subgroup than in the normal-Hcy subgroup (0.94±0.03), (2.21±0.25) (χ²=22.725, t=4.913, 6.545, 4.371, P<0.001). The abundance of Firmicutes was lower in the high-Hcy subgroup than in the normal-Hcy subgroup, while the abundance of Bacteroidetes and Proteobacteria was higher in the high-Hcy subgroup (P<0.05). The abundance of Bacteroides genus was higher in the high-Hcy subgroup than in the normal-Hcy subgroup, while the abundance of Bifidobacterium genus, Faecalibacterium genus, and Collinsella genus was lower in the high-Hcy subgroup (P<0.05). Gut microbiota dysbiosis, Simpson index, and high Hcy were positively correlated with stroke and stroke with Hcy, while Chaol index and Shannon index were negatively correlated with stroke and stroke with Hcy (P<0.05). The area under the curve (AUC) of gut microbiota dysbiosis, Simpson index, Chaol index, and Shannon index for predicting stroke with Hcy in middle-aged and young patients was 0.731 (95%CI: 0.638~0.811), 0.809 (95%CI: 0.723~0878), 0.782 (95%CI: 0.693~0.855), and 0.822 (95%CI: 0.738-0.889), respectively. The sensitivity and specificity were 80.00%, 86.67%, 82.22%, and 75.56%, and 66.15%, 69.23%, 61.54%, and 75.38%, respectively. Conclusion: The incidence of intestinal flora imbalance in middle-aged and young stroke patients with hyperHCY is higher, the diversity is decreased, and the abundance is also significantly changed, which can be used as an auxiliary index to predict stroke patients with hyperHcy, and provide a new perspective for clinical practice.

Key words： Young and middle-aged Stroke Hyperhomocysteinemia Intestinal flora characteristics Alpha diversity Relative abundance Predictive value

基金资助:河北省2024年度医学科学研究课题计划,(编号:20240960)

通讯作者: 姜芳

引用本文:

王学明, 周桃花, 李立婷, 姜芳. 中青年脑卒中伴与不伴高同型半胱氨酸血症患者肠道菌群特征的差异及临床意义[J]. 河北医学, 2024, 30(7): 1191-1197.
WANG Xueming, ZHOU TiaoHua, LI LiTing, et al. Differences in Gut Microbiota Characteristics and Clinical Significance between Middle-aged and Young Stroke Patients with and without Hyperhomocysteinemia. HeBei Med, 2024, 30(7): 1191-1197.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.07.025 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I7/1191

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